National Hypertension Control Initiative (NHCI) Community Health Center Assessment

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form 1 National Hypertension Control Initiative (NHCI) Community Health Center Assessment Form and Instruction
1 National Hypertension Control Initiative (NHCI) Communit 0990-0379 BPHC card sort test script.docx Form and Instruction
0990-0379 NHCI Health Center Assessment Memo-correct.docx Fast Track Memo IC Document

Information Collection (IC) Details

IC Title:	National Hypertension Control Initiative (NHCI) Community Health Center Assessment	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	National Hypertension Control Initiative (NHCI) Community Health Center Assessment	0990-0379 BPHC card sort test script.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Memo	0990-0379 NHCI Health Center Assessment Memo-correct.docx	11/07/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.